Advertisement

Clinical Research in Cardiology

, Volume 96, Issue 3, pp 152–159 | Cite as

Effect of stress-induced reversible ischemia on serum concentrations of ischemia-modified albumin, natriuretic peptides and placental growth factor

  • Kerstin KurzEmail author
  • Ralf Voelker
  • Dietmar Zdunek
  • Ragnhild Wergeland
  • Georg Hess
  • Boris Ivandic
  • Hugo Katus
  • Evangelos Giannitsis
ORIGINAL PAPER

Summary

Objective

There is controversy whether new biomarkers are able to identify myocardial ischemia in the absence of myonecrosis.

Method

We measured NT-pro BNP, NT-pro ANP, ischemia-modified albumin (IMA) and placental growth factor (PlGF) in patients undergoing nuclear stress testing for suspected ischemic heart disease. A thallium scan was used for detection of reversible myocardial ischemia and cardiac troponin T (cTnT) for exclusion of stress-induced myonecrosis. Of 195 patients, 24 with reversible and 62 with no perfusion defect were included in the analysis. Plasma levels were measured before, 18 min and 4 h after stress testing.

Results

Of the 86 patients, 52 received an exercise stress and 34 dipyridamol. New myonecrosis indicated by cTnT could be excluded in all patients. Plasma levels of NT-pro BNP and NT-pro ANP before testing were significantly higher in patients who later developed reversible perfusion defects (NT-pro BNP 139.00 (58.25/367.01) pg/mL vs 327.45 (120.50/972.85) pg/mL, p < 0.05; NT-pro ANP 732.5 (470.0/ 1220.0) pg/mL vs 1470.0 (694.0/ 1910.0) pg/mL, p < 0.05). Plasma levels of NT-pro BNP, NT-pro ANP and PIGF did not change significantly after stress testing, IMA levels rose significantly after 4 h in patients with and without reversible perfusion defects.

Conclusion

The elevation of NTpro BNP and NT-pro ANP at baseline may represent the cumulative effect of repeated bouts of myocardial ischemia. A single brief episode of provoced ischemia does not cause a significant increase of the measured biomarkers beside from IMA after exercise stress test potentially indicating skeletal muscle ischemia.

Key words

Myocardial ischemia biochemical markers troponin 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Apple FS, Quist HE, Otto AP, Mathews WE, Murakami MM (2002) Release characteristics of cardiac biomarkers and ischemia-modified albumin as measured by the albumin cobalt- binding test after a marathon race. Clin Chem 48:1097–1100PubMedGoogle Scholar
  2. 2.
    Borderie D, Allanore Y, Meune C, Devaux JY, Ekindjian OG, Kahan A (2004) High ischemia-modified albumin concentration reflects oxidative stress but not myocardial involvement in systemic sclerosis. Clin Chem 50:2190–2193PubMedCrossRefGoogle Scholar
  3. 3.
    Cummins P, Young A, Auckland ML, Michie CA, Stone PCW, Shepstone DJ (1987) Comparison of serum cardiac specific troponin-I with creatine kinase, creatine kinase-MB, tropomyosin, myoglobin, and C-reactive protein release in marathon runners: cardiac or skeletal muscle trauma. Eur J Clin Invest 17:317–324PubMedCrossRefGoogle Scholar
  4. 4.
    de Lemos JA, Morrow DA, Bentley J H, Omland T, Sabatine MS, McCabe CH, Hall C, Cannon CP, Braunwald E (2001) The prognostic value of Btype natriuretic peptide in patients with acute coronary syndromes. N Engl J Med 345:1014–1021PubMedCrossRefGoogle Scholar
  5. 5.
    Edwards SW, Hallett MB, Campbell AK (1984) Oxygen-radical production during inflammation may be limited by oxygen concentration. Biochem J 217:851–854PubMedGoogle Scholar
  6. 6.
    Fishbein MC, Wang T, Matijasevic M, Hong L, Apple FS (2003) Myocardial tissue troponins T and I. An immunohistochemical study in experimental models of myocardial ischemia. Cardiovasc Pathol 12:65–71PubMedCrossRefGoogle Scholar
  7. 7.
    Foote RS, Pearlman JD, Siegel AH, Yeo KT (2004) Detection of exerciseinduced ischemia by changes in Btype natriuretic peptides. J Am Coll Cardiol 44:1980–1987PubMedCrossRefGoogle Scholar
  8. 8.
    Giannitsis E (2005) Rationale for testing the cardiovascular risk for patients with COX-2 inhibitors on the basis of biomarker NT-proBNP. Clin Lab 51:63–83PubMedGoogle Scholar
  9. 9.
    Goetze JP, Christoffersen C, Perko M, Arendrup H, Rehfeld JF, Kastrup J, Nielsen LB (2003) Increased cardiac BNP expression associated with myocardial ischemia. FASEB J 17:1105–1107PubMedGoogle Scholar
  10. 10.
    Heeschen C, Dimmeler S, Fichtlscherer S, Hamm CW, Berger J, Simoons ML, Zeiher AM (2004) CAPTURE Investigators. Prognostic value of placental growth factor in patients with acute chest pain. JAMA 291:435–441PubMedCrossRefGoogle Scholar
  11. 11.
    Herrmann M, Scharhag J, Miclea M, Urhausen A, Herrmann W, Kindermann W (2003) Post-race kinetics of cardiac troponin T and I and N-terminal pro-brain natriuretic peptide in marathon runners. Clin Chem 49:831–834PubMedCrossRefGoogle Scholar
  12. 12.
    Konstantinides S, Geibel A, Olschewski M, Kasper W, Hruska N, Jackle S, Binder L (2002) Importance of cardiac troponins I and T in risk stratification of patients with acute pulmonary embolism. Circulation 106:1263–1268PubMedCrossRefGoogle Scholar
  13. 13.
    Kragelund C, Gronning B, Kober L, Hildebrandt P, Steffensen R (2005) N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease. N Engl J Med 352:666–675PubMedCrossRefGoogle Scholar
  14. 14.
    Marumoto K, Hamada M, Hiwada K (1995) Increased secretion of atrial and brain natriuretic peptides during acute myocardial ischaemia induced by dynamic exercise in patients with angina pectoris. Clin Sci 88:551–556PubMedGoogle Scholar
  15. 15.
    McNairy M, Gardetto N, Clopton P, Garcia A, Krishnaswamy P, Kazanegra R, Ziegler M, Maisel AS (2002) Stability of B-type natriuretic peptide levels during exercise in patients with congestive heart failure: implications for outpatient monitoring with B-type natriuretic peptide. Am Heart J 143:406–411PubMedCrossRefGoogle Scholar
  16. 16.
    Muller-Bardorff M, Weidtmann B, Giannitsis E, Kurowski V, Katus HA (2002) Release Kinetics of Cardiac Troponin T in Survivors of Confirmed Severe Pulmonary Embolism. Clin Chem 48:673–675PubMedGoogle Scholar
  17. 17.
    Nishimura K, Ban T, Saito Y, Nakao K, Imura H (1990) Atrial pacing stimulates secretion of atrial natriuretic polypeptide without elevation of atrial pressure in awake dogs with experimental complete atrioventricular block. Circ Res 66:115–122PubMedGoogle Scholar
  18. 18.
    Ohba H, Takada H, Musha H, Nagashima J, Mori N, Awaya T, Omiya K, Murayama M (2001) Effects of prolonged strenuous exercise on plasma levels of atrial natriuretic peptide and brain natriuretic peptide in healthy men. Am Heart J 141:751–758PubMedCrossRefGoogle Scholar
  19. 19.
    Omland T, Richards AM, Wergeland R, Vik-Mo H (2005) B-type natriuretic peptide and long-term survival in patients with stable coronary artery disease. Am J Cardiol 95:24–28PubMedCrossRefGoogle Scholar
  20. 20.
    Pfister R, Scholz M, Wielckens K, Erdmann E, Schneider C (2004) A Use of NT-proBNP in routine testing and comparison to BNP. Eur J Heart Fail 6:289–293PubMedCrossRefGoogle Scholar
  21. 21.
    Roy D, Quiles J, Sharma R, Sinha M, Avanzas P, Gaze D, Kaski JC (2004) Ischemia-modified albumin concentrations in patients with peripheral vascular disease and exercise-induced skeletal muscle ischemia. Clin Chem 50:1656–1660PubMedCrossRefGoogle Scholar
  22. 22.
    Roy D, Quiles J, Sinha M, Floros D, Gaze D, Collinson P, Baxter GF, Kaski JC (2004) Effect of radiofrequency catheter ablation on the biochemical marker ischemia modified albumin. Am J Cardiol 94:234–236PubMedCrossRefGoogle Scholar
  23. 23.
    Sabatine MS, Morrow DA, de Lemos JA, Omland T, Desai MY, Tanasijevic M, Hall C, McCabe CH, Braunwald E (2004) Acute changes in circulating natriuretic peptide levels in relation to myocardial ischemia. J Am Coll Cardiol 44:1988–1995PubMedCrossRefGoogle Scholar
  24. 24.
    Sinha MK, Gaze DC, Tippins JR, Collinson PO, Kaski JC (2003) Ischemia modified albumin is a sensitive marker of myocardial ischemia after percutaneous coronary intervention. Circulation 107:2403–2405PubMedCrossRefGoogle Scholar
  25. 25.
    Sinha MK, Roy D, Gaze DC, Collinson PO, Kaski JC (2004) Role of "Ischemia modified albumin", a new biochemical marker of myocardial ischaemia, in the early diagnosis of acute coronary syndromes. Emerg Med J 21:29–34PubMedCrossRefGoogle Scholar
  26. 26.
    Weber M, Dill T, Arnold R, Rau M, Ekinci O, Muller KD, Berkovitsch A, Mitrovic V, Hamm C (2004) N-terminal B-type natriuretic peptide predicts extent of coronary artery disease and ischemia in patients with stable angina pectoris. Am Heart J 148:612–620PubMedCrossRefGoogle Scholar
  27. 27.
    Wu AH, Smith A, Wieczorek S, Mather JF, Duncan B, White CM, McGill C, Katten D, Heller G (2003) Biological variation for N-terminal pro- and B-type natriuretic peptides and implications for therapeutic monitoring of patients with congestive heart failure. Am J Cardiol 92:628–631PubMedCrossRefGoogle Scholar
  28. 28.
    Yasue H, Yoshimura M, Sumida H, Kikuta K, Kugiyama K, Jougasaki M, Ogawa H, Okumura K, Mukoyama M, Nakao K (1994) Localization and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure. Circulation 90:195–203PubMedGoogle Scholar
  29. 29.
    Zapico-Muniz E, Santalo-Bel M, Merce-Muntanola J, Montiel JA, Martinez- Rubio A, Ordonez-Llanos J (2004) Ischemia-modified albumin during skeletal muscle ischemia. Clin Chem 50:1063–1065PubMedCrossRefGoogle Scholar

Copyright information

© Steinkopff-Verlag 2006

Authors and Affiliations

  • Kerstin Kurz
    • 1
    Email author
  • Ralf Voelker
    • 1
  • Dietmar Zdunek
    • 2
  • Ragnhild Wergeland
    • 3
  • Georg Hess
    • 2
  • Boris Ivandic
    • 1
  • Hugo Katus
    • 1
  • Evangelos Giannitsis
    • 1
  1. 1.Abteilung Innere Medizin III, Medizinische KlinikUniversitätsklinikum HeidelbergHeidelbergGermany
  2. 2.Roche Diagnostics GmbHMannheimGermany
  3. 3.Institute of Clinical ChemistryRikshospitaletOsloNorway

Personalised recommendations